Electrical Cardioversion for AF—The State of the Art

Gall, Nicholas; Murgatroyd, Francis

doi:10.1111/j.1540-8159.2007.00709.x

Cited by 40 publications

(51 citation statements)

References 120 publications

(120 reference statements)

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“…As stated previously, AF is a significant cause of both morbidity and mortality. AF can potentiate structural cardiac remodeling if left untreated; cardioversion (CV) may be important in preventing this remodeling (102 ) and restoring sinus rhythm is considered an important therapeutic goal in patients who are younger or highly symptomatic (97 ). Concern has been expressed about the possible myocardial damage caused by CV, and studies demonstrating a wide range of cTn values as a result of CV have been published (see Table 4).…”

Section: Noninvasive Proceduresmentioning

confidence: 99%

Increases of Cardiac Troponin in Conditions other than Acute Coronary Syndrome and Heart Failure

2009

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Background: Although cardiac troponin (cTn) is a cornerstone marker in the assessment and management of patients with acute coronary syndrome (ACS) and heart failure (HF), cTn is not diagnostically specific for any single myocardial disease process. This narrative review discusses increases in cTn that result from acute and chronic diseases, iatrogenic causes, and myocardial injury other than ACS and HF.Content: Increased cTn concentrations have been reported in cardiac, vascular, and respiratory disease and in association with infectious processes. In cases involving acute aortic dissection, cerebrovascular accident, treatment in an intensive care unit, and upper gastrointestinal bleeding, increased cTn predicts a longer time to diagnosis and treatment, increased length of hospital stay, and increased mortality. cTn increases are diagnostically and prognostically useful in patients with cardiac inflammatory diseases and in patients with respiratory disease; in respiratory disease cTn can help identify patients who would benefit from aggressive management. In chronic renal failure patients the diagnostic sensitivity of cTn for ACS is decreased, but cTn is prognostic for the development of cardiovascular disease. cTn also provides useful information when increases are attributable to various iatrogenic causes and blunt chest trauma.Summary: Information on the diagnostic and prognostic uses of cTn in conditions other than ACS and heart failure is accumulating. Although increased cTn in settings other than ACS or heart failure is frequently considered a clinical confounder, the astute physician must be able to interpret cTn as a dynamic marker of myocardial damage, using clinical acumen to determine the source and significance of any reported cTn increase.

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Section: Noninvasive Proceduresmentioning

confidence: 99%

Increases of Cardiac Troponin in Conditions other than Acute Coronary Syndrome and Heart Failure

2009

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“…In contrast to pharmacological cardioversion, ECV is the most effective alternative to revert persistent AF back to normal sinus rhythm (NSR), especially if the arrhythmia has been present for more than 24 hours [1]. Although the ECV success rate is high, AF recurrence is common, especially during the first 2 weeks following the procedure [2].…”

Section: Introductionmentioning

confidence: 99%

“…Although the ECV success rate is high, AF recurrence is common, especially during the first 2 weeks following the procedure [2]. Moreover, ECV also has the potential of causing severe collateral effects, such as post-shock bradycardia, malignant ventricular arrhythmias, arterial thromboembolism and complications related to anaesthesia [1]. Hence, it would be clinically very useful to predict NSR maintenance after ECV, before it is attempted.…”

Section: Introductionmentioning

confidence: 99%

Predicting Electrical Cardioversion outcome from surface ECG recordings through Wavelet Sample Entropy

Alcaraz

Rieta

2008

2008 Computers in Cardiology

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Electrical Cardioversion (ECV) is the most effective alternative to revert persistent atrial fibrillation (PAF) back to normal sinus rhythm (NSR). It would be clinically useful to predict NSR maintenance likelihood after ECV before it is attempted because of the high atrial fibrillation (AF) risk of recurrence and because of the potential secondary effects of ECV. In previous studies, other parameters have been deeply analyzed, but their results were very different and, consequently, inconclusive. Thereby, this work presents a new non-invasive predictor of ECV outcome before it is attempted. This method is based on the suitable combination of the Wavelet Transform (WT) and sample entropy (SampEn), which is a non-linear regularity index, and is called Wavelet Sample Entropy (WSE). Results indicated that 17 out of 21 (80.95%) ECVs relapsing to AF and 12 out of 14 (85.71%) ECVs resulting in NSR after the first month were correctly discriminated. The recordings that relapsed to AF presented higher SampEn values (0.0320 ± 0.0053) than the recordings in NSR (0.0271 ± 0.0045). In addition, the five patients in which NSR was not restored in any case, presented the highest SampEn values (0.0350 ± 0.0028).

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“…In one series of 1.838 eletrical CV, success rates, when the duration of AF was <30, 30 to 90, 90 to 180, and >180 days was 84, 78, 77, and 66 percent, respectively.53 When AF has been present for more than five years, success rates are only approximately 50 percent [50]. Indications and contraindications of AF/AFL is given in Table 9 [5,6,54,55]. Technique Electrical CV should be performed with the patient in a fasting state under adequate sedation for elective cases.…”

Section: Electrical Cardioversion Of Af/afl In Edmentioning

confidence: 99%

Cardioversion of recent-onset atrial fibrillation and flutter in the emergency department

Beton¹,

Yılmaz²,

Korkmaz³

et al. 2014

CMJ

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Atrial fibrillation (AF) is the most common arrhythmia encountered in acute medical practice. One-third of hospitalizations for cardiac rhythm disturbances are attributed to AF, with increasing rates in the past decade. Significant morbidity and mortality, including 15% to 20% of all ischemic strokes and 20% of all strokes, result from AF. The overall mortality rate for patients with AF is approximately double that for patients in normal sinus rhythm. Atrial flutter (AFL) has many clinical aspects that are similar to AF, AF and AFL have same management strategies in emergency settings. The major goals of treatment include alleviation of the associated symptoms and/or hemodynamic disturbance, reduction of the risk of systemic thromboembolism, reduction in hospital length of stay. The very large scaled AFFIRM and AF-CHF clinical trials compared rate and rhythm control (cardioversion), but did not explore the optimal management for recent-onset AF/AFL patients presenting to the emergency department (ED) with in 48 hours of symptoms. Although international standard guidelines are available, AF treatment in ED is still heterogeneous in terms of the management strategy (rate or rhythm) chosen. National based guidelines or consensus documents specific to ED management of AF has recently been developed and published in order to solve this problem. Aim of this review is to give detailed information for ED team about echocardiographic criterias supporting cardioversion (CV) of AF, CV procedure itself and new antiarrhythmic and oral anticoagulant drugs by adhering to the guidelines. Keywords: Cardioversion, recent-onset atrial fibrillation, flutter, emergency ÖzetAtriyal fibrilasyon, akut tıbbi uygulamada karşılaşılan en sık aritmidir. Kalp ritm bozuklukları nedeniyle hastaneye yatanların üçte birinde neden AF olup son on yılda sıklığı giderek artmaktadır. AF belirgin mortalite ve morbiditeye neden olmaktadır. Tüm iskemik inmelerin %15-%20'si ve tüm inmelerin %20'si AF nedenlidir. AF'si olan hastalarda genel ölüm oranı, normal sinus ritmi olanlara göre yaklaşık iki kat fazladır. Atriyal flutter (AFL)'in AF'e benzer birçok klinik yönleri bulnumaktadır, acil durumlarda AF ve AFL aynı tedavi stratejilerine sahiptir. Tedavinin başlıca hedefleri, ilgili semptom ve/veya hemodinamik bozukluğun azaltılması, sistemik tromboembolik riskin azaltılması ve hastanede kalış süresinin kısaltılmasını içermektedir. Çok büyük ölçekli AFFIRM ve AF-CHF çalışmaları, hız ve ritim kontrolü (kardiyoversiyon) stratejilerini kıyasladı, fakat, semptom başlangıcının 48 saati içerisinde acile servise(AS) başvuran, yeni başlangıçlı AF/AFL hastalarında optimal tedavi yöntemini açığa kavuşturamadı. Uluslararası standart kılavuzlar bulunmasına rağmen AS'de AF tedavisi, seçilen tedavi stratejisi (hız veya ritim) yönünden hala heterojendir. Son zamanlarda bu sorunu çözmek amacıyla, AS'de AF tedavisine yönelik ulusal kaynaklı kılavuzlar ve konsensüs belgeleri geliştirilmiş ve yayınlanmıştır. Bu derlemenin amacı, AS ekibine, kılavuzlara bağlı kalınarak...

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Electrical Cardioversion for AF—The State of the Art

Cited by 40 publications

References 120 publications

Increases of Cardiac Troponin in Conditions other than Acute Coronary Syndrome and Heart Failure

Increases of Cardiac Troponin in Conditions other than Acute Coronary Syndrome and Heart Failure

Predicting Electrical Cardioversion outcome from surface ECG recordings through Wavelet Sample Entropy

Cardioversion of recent-onset atrial fibrillation and flutter in the emergency department

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